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INTRODUCTION TO MEDICAL PSYCHOLOGY Lecture 1
Transcript of INTRODUCTION TO MEDICAL PSYCHOLOGY Lecture 1
Medical psychology: an interference domain between medicine and psychosocial sciences
Concepts of Health and
Discussing the complexities of what constitutes a disease requires careful distinction among related, but distinct concepts.
In 1973, Susser, an epidemiologist, proposed some definitions that remain useful.
to refer to the subjective sense of feeling unwell;
does not define a specific pathology, but refers to a person’s subjective experience of it, such as discomfort, tiredness, or general malaise
Disease’ implies a focus on pathological processes that may or may not produce symptoms and that result in a patient’s illness. For example, a patient complains of tiredness and malaisehis illness as he experiences it. He consults a doctor about itbecause he believes that he might have a sickness. The doctor might attribute the patient’s symptoms to a thyroid conditiona disease.
1) Clinical psychology
3) Physiological psychology and psychological physiology.
4) Abnormal psychology
5) Health psychology
6) Psychosomatic medicine
7) Behavioral medicine
INTRODUCTION TO MEDICAL PSYCHOLOGY Lecture 1
Andria spyridou dr. Nat. SC.
is a branch of applied psychology devoted to psychological problems arising in the practice of medicine, including psychological aspects of pain, terminal illness, bereavement, disability, and reactions to medical advice
It is related with several other fields of psychology.
BIOLOGICAL MEDICAL MODEL
"the traditional approach to the diagnosis and treatment of illness as practiced by physicians in the Western world since the time of Koch and Pasteur. The physician focuses on the defect, or dysfunction, within the patient, using a problem-solving approach. The medical history, physical examination, and diagnostic tests provide the basis for the identification and treatment of a specific illness. The medical model is thus focused on the physical and biologic aspects of specific diseases and conditions. Nursing differs from the medical model in that the patient is perceived primarily as a person relating to the environment holistically; nursing care is formulated on the basis of a holistic nursing assessment of all dimensions of the person (physical, emotional, mental, and spiritual) that assumes multiple causes for the problems experienced by the patient. Nursing care then focuses on all dimensions, not just physical."
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
According to the biopsychosocial model, it is the interaction between one's genetic makeup (i.e., biology), mental health and personality (i.e., psychology), and sociocultural environment (i.e., social) that contribute to health or illness.
The biological influences on mental health and mental illness are varied, and include genetics, infections, physical trauma, nutrition, hormones, and toxins.
The psychological component looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.
Social and cultural factors are conceptualized as a particular set of stressful events (e.g., losing one's job) that can differentially impact mental health depending on the individual and the social context in which they live.
The biopsychosocial theory posits that each one of these factors is not sufficient to bring about health or mental illness, but the interaction between them determines the course of one's development.
Despite its usefulness, there are issues with the biopsychosocial model including the degree of influence that each factor has, the degree of interaction between factors, and variation across individuals and life spans.
Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine. It may include preventive medicine and patient-centered medicine.
Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques, under the umbrella term complementary and alternative medicine, or CAM.
Integrative medicine is the combination of the practices and methods of alternative/complementary medicine with conventional medicine.
It may include preventive medicine and patient-centered medicine.
Mind-body medicine takes a holistic approach to health that explores the interconnection between the mind, body, and spirit.
The way a patient reports symptoms is influenced by his or her cultural background,
Susser applied the term
’ to refer to socially and culturally held conceptions of health conditions (e.g., the dread of cancer or the stigma of mental illness), which in turn influence how the patient reacts
The social perceptions of disease that Illich described modify the ways a patient perceives and presents his symptoms.
Cultural conventions likewise affect where the boundary between disease and non-disease is placed: menopause may be considered a health issue in North America, but symptoms are far less commonly reported in Japan.
of disease has dominated medical thinking since the time of Louis Pasteur (18221895) and the microbiological revolution. This model focuses on pathological processes, and on understanding, diagnosing, and treating the physical and biological aspects of disease. The goal of treatment is to restore the patient’s physiological integrity and function.
Diagnosis involves recognizing and applying a label to a pattern of signs and symptoms that is at least partly understood in terms of abnormal structure or function of cells, organs, and systems.
This offers a rational basis for the investigation of effective treatments. For instance, a certain pattern of chest pain known as angina pectoris is understood biologically as a disorder of the coronary arteries that causes cardiac ischeamia, and the treatments are geared to the specific causes of restoring cardiac blood flow and reducing cardiac effort.
Early biomedical conceptions supposed that a disease is either present or absent: a bacterium has invaded the body or it has not.
However, as medicine increasingly tackled conditions, such as hypertension, which represent deviations from normal values, which themselves have a range and can be debated, it became apparent that there may be no set threshold for defining disease.
Thus, instead of being seen as a state that is qualitatively distinct from health, many diseases have to be approached as a quantitative threshold on a continuum of biological variability (see Nerd’s Corner box on alternative definitions of disease).
Organizations such as the World Health Organization (WHO) and the National Institutes of Health have proposed different classifications of hypertension and have changed how they constitute hypertension over time.
Hypertension can be mild, moderate or severe, or defined as pre-hypertension or hypertension stage 1 or stage 2.
Definitions of Health
If there are complexities in defining disease, there are even more in defining health.
Definitions have evolved over time. In keeping with the biomedical perspective, early definitions of health focused on the theme of the body’s ability to function; health was seen as a state of normal function that could be disrupted from time to time by disease.
An example of such a definition of health is: "a state characterized by
to perform personally, valued family, work, and community roles; ability to deal with physical, biologic, psychological, and social stress".
In 1948, in a radical departure from previous definitions, the
proposed a definition that aimed higher, linking health to well-being, in terms of "
physical, mental, and social well-being, and not merely the absence of disease and infirmity
Although this definition was welcomed by some as being innovative and exciting, it was also criticized as being vague, excessively broad, and unmeasurable.
For a long time it was set aside as an impractical ideal and most discussions of health returned to the practicality of the biomedical model.
Health as a Resource
the WHO played a leading role when it fostered the development of the health promotion movement in the 1980s.
This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as "a resource for living".
The 1984 WHO revised definition of health defined it as "
the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities"
Thus, health referred to the
ability to maintain homeostasis
and recover from insults.
Mental, intellectual, emotional, and social health referred to a person’s
ability to handle stress,
acquire skills, to maintain relationships
, all of which form resources for resiliency and independent living.
But with so much disease to treat, should physicians concern themselves with wellness? Is it appropriate for medicine to seek ways to promote positive health states?
Some academics distinguish between a medical care system and a health care system, arguing that, to constrain costs, public funding should be limited to treating illness and restoring the patient’s functional capacity.
Others note that activities such as counseling and educating healthy individuals on diet and exercise promote wellness and resiliency, and so fall within the scope of normal practice as a part of preventive medicine.
This chapter opened with the theme of rising aspirations and the resulting reconceptualization of disease and health.
In response, many practitioners have expanded their focus to include wellness at the positive end of the health continuum.
Some distinguish two interacting dimensions: disease versus non-disease and well-being versus ill-being; others expand the number of dimensions to include spiritual, emotional, social, and mental.
Last commented that wellness is "
a word used by behavioural scientists to describe a state of dynamic physical, mental, social, and spiritual well-being that enables a person to achieve full potential and an enjoyable life
Disease as a Process: Natural History and Clinical Course
The nineteenth-century revolution in thinking brought about by Koch and Pasteur led to the recognition of distinct stages in the development of a disease. If left untreated, a disease would evolve through a series of stages that characterize its natural history. But if an intervention is applied, the natural history is modified, producing a typical clinical course for the condition
1. What is medical Psychology
2. The Biological medical Model, the Biopsychosocial Model, Integrative Model
3. Concepts of Health-Disease, Illness and Sickness
4. Definitions of Health & development in the past century